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Thanks to Dr. Nanda Patil, Dr. Saket Kumar and Dr. Sharda Sarda, Krishna Institute of Medical Sciences (India), for contributing this case. To contribute a Case of the Week, follow the guidelines on our Case of the Week page.

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Case of the Week #366

Clinical history:
A 63 year old woman presented with a six year history of gradually increasing swelling of the lateral aspect of the right knee, now 10 x 10 cm. There was no pain, discharge or history of trauma.

MRI revealed a well defined, lobulated lesion in the anterolateral aspect of the subcutaneous plane of the distal right thigh with areas of haemorrhage and necrosis, suggestive of sarcoma.

No evidence of metastatic disease was identified with chest Xray and other investigations. The lesion and overlying skin were excised.

Discussion:
Microscopy revealed cords, nests and clusters of spindled and stellate cells with scanty to moderate amphophilic cytoplasm, uniform dark staining nuclei and indistinct nucleoli. These cells were dispersed within a myxoid stroma, which was positive for Alcian Blue at pH 4.0 and 5.0, suggesting the presence of chondroitin sulfate.

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